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Need information to give to my doctor in regards to T3 and suppressed TSH.
My Armour medication is being lowered today. Here are my lab results.
TSH .03 ( .44 - 3.98 )
Free T3 .75 ( .78 - 1.48 )
Free T4 2.9 (1.8 - 4.2 )
Vitamin D 32 Optimum Level 30 - 80
B-12 310 211-911
Magnesium, Serum 2.00 ( 1.80 - 2.40 )
Obviously, he's looking only at my TSH. I had really thought I had found a good doctor, but no. I'm still in shock.
TSH .03 ( .44 - 3.98 )
Free T3 .75 ( .78 - 1.48 )
Free T4 2.9 (1.8 - 4.2 )
Vitamin D 32 Optimum Level 30 - 80
B-12 310 211-911
Magnesium, Serum 2.00 ( 1.80 - 2.40 )
Obviously, he's looking only at my TSH. I had really thought I had found a good doctor, but no. I'm still in shock.
Looking at your Free T4 and Free T3 values both in lower reference range particularly Free T3.
Your TSH values are super low in spite of low Free T4 which means pituitary gland failing to produce enough TSH. So no need to worry about your TSH values instead ask doctor to raise levothyroxine dose. If dessicated thyroid pill is available that will better as it have both T4 and T3.
Osteoporosis and other complications occur due to excess thyroid hormones and in your case its not though TSH very low.
Concerning vitamin B12 and D you need to keep supplementing till it reach optimum values. Also make sure you add zinc and selenium rich foods in your diet.
Your TSH values are super low in spite of low Free T4 which means pituitary gland failing to produce enough TSH. So no need to worry about your TSH values instead ask doctor to raise levothyroxine dose. If dessicated thyroid pill is available that will better as it have both T4 and T3.
Osteoporosis and other complications occur due to excess thyroid hormones and in your case its not though TSH very low.
Concerning vitamin B12 and D you need to keep supplementing till it reach optimum values. Also make sure you add zinc and selenium rich foods in your diet.
If your results should be switched then your FT3 level IS over the top of the range! In which case a decrease might be the right thing to do.
however how are your feeling? what symptoms are you having?
Your D3 is far from "optimum". It could be higher as you are literally floating near the very rock bottom of the apparently "optimum" range. I'd try to get up towards the middle of that range!
Also yur B-12 is woefully low. Many nations such as Japan the very bottom of the "normal" range does not even start until 500. And you are only testing at just over 300. Many people do not feel well until their B-12 is towards the very upper part of the range. As in over 700 if not even 1,000. So you might want to consider supplmenting both D3 and B-12
Please confirm your proper and corrected lab results. do to the switching error, it may make sense to repost the corrected lab results so you get the correct advice.
however how are your feeling? what symptoms are you having?
Your D3 is far from "optimum". It could be higher as you are literally floating near the very rock bottom of the apparently "optimum" range. I'd try to get up towards the middle of that range!
Also yur B-12 is woefully low. Many nations such as Japan the very bottom of the "normal" range does not even start until 500. And you are only testing at just over 300. Many people do not feel well until their B-12 is towards the very upper part of the range. As in over 700 if not even 1,000. So you might want to consider supplmenting both D3 and B-12
Please confirm your proper and corrected lab results. do to the switching error, it may make sense to repost the corrected lab results so you get the correct advice.
Absolutely get a second opinion. Your free t3 is not in range, which I'm sure has you feeling super tired and crappy. However, he has a point in being concerned because your body is not doing a good job converting you t4 into t3. There are a number of reasons this can be happening like selenium and zinc deficiency, stress, and so forth. Be sure to look that up as that is most likely going to be your solution not just more medication.
He doesn't have a "different grasp on it", he has no grasp at all. LOL Time to find a good thyroid doctor.
Following are a couple of links and quotes from each that you can use.
Shimon I, Cohen O. Lubetsky A. Olchovsky D. Thyrotropin Suppression by Thyroid Hormone Replacement Is Correlated With Thyroxine Level Normalization In Central Hypothyroidism. Thyroid 2002 Sep;823-7
“Plotting measurements of TSH against FT4 for 6 individuals with central hypothyroidism showed different regression slope for each patient. Suppression of TSH by thyroid replacement to levels below .1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p< .0001). In conclusion in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment. “
Igor D, Duffy MJ, McKenna TJ, TSH As An Index of L-Thyroxine Replacement and Suppression Therapy. Ir J Med Sci 1992 Dec;161(12):684-6
“Suppressed TSH levels were associated with elevated FT4 levels in 37.5% of patients and normal FT4 levels in 62.5%”
And if the doctor tries to say that suppressed TSH will cause osteoporosis, you can give him this info.
Appetecchia M, Effects On Bone Mineral Density by Treatment of Benign Nodular Goitre with Mildly Suppressive Doses of L-Thyroxine in a Cohort Women Study.
“This study suggests that at slightly suppressing TSH doses, LT4 therapy has no adverse effects on BMD in both pre- and postmenopausal women, while having an efficacy on nodule size comparable with that reported using an LT4 schedule able to maintain TSH near or below the assay sensitivity limit.”
Bauer DC, Nevitt MC, Ettinger B, Stone K. Low Thyrotropin Levels are not Associated with Bone Loss in Older Women: A Prospective Study.
“We found no consistent evidence that low TSH a sensitive biomarker of excess thyroid hormone, was associated with low BMD or accelerated bone loss in older ambulatory women.”
Fujiyama K, et al. Suppressive Doses of Thyroxine Do Not Accelerate Age-Related Bone Loss In Late Postmenopausal Women. Thyroid, 1995 Feb;5(1):13-7.
There was no difference in bone metabolic markers and incidence of vertebral deformity between the groups. ………These prospective and cross-sectional data suggest that long-term levothyroxine therapy using suppressive doses has no significant adverse effects on bone.”
R Schneider and C Reiners, The Effect of Levothyroxine Therapy on Bone Mineral Density: A Systematic Review of the Literature. Clinic for Nuclear Medicine, University of Würzburg, Germany. Experimental and Clinical Endocrinology & Diabetes (Impact Factor: 1.56). 01/2004; 111(8):455-70. DOI: 10.1055/s-2003-44704
Of 63 identified studies, 31 studies reported no effects of levothyroxine on bone mineral density, 23 studies showed partial beneficial or adverse, and 9 studies overall adverse effects. A significant dose-response was not found. There was a tendency towards peripheral cortical bone loss, suggesting a site-specific effect. In adolescents, men, and premenopausal women evidence for levothyroxine influence was weaker than in postmenopausal women. However, also findings in postmenopausal women remained unclear. The extent and etiology of underlying thyroid diseases also contributed to inconsistent results. Further, controversial results were due to substantial heterogeneity of studies. Above all, studies were limited by moderate quality, small size, and inadequate control for confounders. Based on current studies there is insufficient evidence about effectiveness of levothyroxine on bone mineral density.”
Grant DJ, McMurdo ME, Mole PA, Paterson CR, Davies RR, Suppressed TSH Levels Secondary to Thyroxine Replacement Therapy are not Associated with Osteoporosis. Clin Endocrinol (osf) 1993 Nov;39(5):529-33
“In this patient population, the reduction in bone mineral density due to thyroxine is small. It is unlikely to be of clinical significance and should not on its own be an indication for reduction of thyroxine dose in patients who are clinically euthyroid.
Lindner, H http://hormonerestoration.com/files/ThyroidPMD.pdf
“Thyroid hormone does not cause bone loss, it simply increases metabolism and therefore the rate of the current bone formation or loss. Most older women are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism, but the correction of their other deficiencies.”
Shimon I, Cohen O. Lubetsky A. Olchovsky D. Thyrotropin Suppression by Thyroid Hormone Replacement Is Correlated With Thyroxine Level Normalization In Central Hypothyroidism. Thyroid 2002 Sep;823-7
“Plotting measurements of TSH against FT4 for 6 individuals with central hypothyroidism showed different regression slope for each patient. Suppression of TSH by thyroid replacement to levels below .1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p< .0001). In conclusion in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment. “
Igor D, Duffy MJ, McKenna TJ, TSH As An Index of L-Thyroxine Replacement and Suppression Therapy. Ir J Med Sci 1992 Dec;161(12):684-6
“Suppressed TSH levels were associated with elevated FT4 levels in 37.5% of patients and normal FT4 levels in 62.5%”
And if the doctor tries to say that suppressed TSH will cause osteoporosis, you can give him this info.
Appetecchia M, Effects On Bone Mineral Density by Treatment of Benign Nodular Goitre with Mildly Suppressive Doses of L-Thyroxine in a Cohort Women Study.
“This study suggests that at slightly suppressing TSH doses, LT4 therapy has no adverse effects on BMD in both pre- and postmenopausal women, while having an efficacy on nodule size comparable with that reported using an LT4 schedule able to maintain TSH near or below the assay sensitivity limit.”
Bauer DC, Nevitt MC, Ettinger B, Stone K. Low Thyrotropin Levels are not Associated with Bone Loss in Older Women: A Prospective Study.
“We found no consistent evidence that low TSH a sensitive biomarker of excess thyroid hormone, was associated with low BMD or accelerated bone loss in older ambulatory women.”
Fujiyama K, et al. Suppressive Doses of Thyroxine Do Not Accelerate Age-Related Bone Loss In Late Postmenopausal Women. Thyroid, 1995 Feb;5(1):13-7.
There was no difference in bone metabolic markers and incidence of vertebral deformity between the groups. ………These prospective and cross-sectional data suggest that long-term levothyroxine therapy using suppressive doses has no significant adverse effects on bone.”
R Schneider and C Reiners, The Effect of Levothyroxine Therapy on Bone Mineral Density: A Systematic Review of the Literature. Clinic for Nuclear Medicine, University of Würzburg, Germany. Experimental and Clinical Endocrinology & Diabetes (Impact Factor: 1.56). 01/2004; 111(8):455-70. DOI: 10.1055/s-2003-44704
Of 63 identified studies, 31 studies reported no effects of levothyroxine on bone mineral density, 23 studies showed partial beneficial or adverse, and 9 studies overall adverse effects. A significant dose-response was not found. There was a tendency towards peripheral cortical bone loss, suggesting a site-specific effect. In adolescents, men, and premenopausal women evidence for levothyroxine influence was weaker than in postmenopausal women. However, also findings in postmenopausal women remained unclear. The extent and etiology of underlying thyroid diseases also contributed to inconsistent results. Further, controversial results were due to substantial heterogeneity of studies. Above all, studies were limited by moderate quality, small size, and inadequate control for confounders. Based on current studies there is insufficient evidence about effectiveness of levothyroxine on bone mineral density.”
Grant DJ, McMurdo ME, Mole PA, Paterson CR, Davies RR, Suppressed TSH Levels Secondary to Thyroxine Replacement Therapy are not Associated with Osteoporosis. Clin Endocrinol (osf) 1993 Nov;39(5):529-33
“In this patient population, the reduction in bone mineral density due to thyroxine is small. It is unlikely to be of clinical significance and should not on its own be an indication for reduction of thyroxine dose in patients who are clinically euthyroid.
Lindner, H http://hormonerestoration.com/files/ThyroidPMD.pdf
“Thyroid hormone does not cause bone loss, it simply increases metabolism and therefore the rate of the current bone formation or loss. Most older women are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism, but the correction of their other deficiencies.”
2 Comments
Thank you so much! You can take him off your list, I would think anyway. I explained to him that my T4 level was not even in range and how was lowering my medication going to help? He just completely ignored me and came up with the bone loss thing.
This was his response:
I appreciate the information, and have now reviewed it as you requested. I feel I do understand it, however have a slightly different grasp on it than you do. My recommendations that we discussed still stand, however I appreciate your input. I certainly feel that it may benefit you to get a second opinion in this regards. Thank you.
I appreciate the information, and have now reviewed it as you requested. I feel I do understand it, however have a slightly different grasp on it than you do. My recommendations that we discussed still stand, however I appreciate your input. I certainly feel that it may benefit you to get a second opinion in this regards. Thank you.
Just remembered too that he said too low of TSH will cause osteoporosis. Is that true?
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